﻿<%@page import="com.cchr.acms.model.Action"%>
<%@page import="com.cchr.acms.model.AbuseType"%>
<%@page import="com.cchr.acms.util.HtmlComponentUtil.SelectOption"%>
<%@page import="java.util.List"%>
<%@page import="com.cchr.acms.util.HtmlComponentUtil"%>
<%@ page language="java" contentType="text/html; charset=UTF-8"   pageEncoding="UTF-8"%>
<%@ taglib prefix="c" uri="http://java.sun.com/jsp/jstl/core"%>
<%@ taglib uri="http://java.sun.com/jsp/jstl/fmt" prefix="fmt" %>
<%
	String contextPath = request.getContextPath();
%>
<!DOCTYPE html>
<!--[if IE 8]>         <html class="ie8"> <![endif]-->
<!--[if IE 9]>         <html class="ie9 gt-ie8"> <![endif]-->
<!--[if gt IE 9]><!--> <html class="gt-ie8 gt-ie9 not-ie"> <!--<![endif]-->
<head>
	<meta charset="utf-8">
	<meta http-equiv="X-UA-Compatible" content="IE=edge,chrome=1">
	<title>Report Psychiatric Abuse</title>
	<meta name="viewport" content="width=device-width, initial-scale=1.0, user-scalable=no, minimum-scale=1.0, maximum-scale=1.0">

	<!-- Open Sans font from Google CDN -->
	<link href="http://fonts.googleapis.com/css?family=Open+Sans:300italic,400italic,600italic,700italic,400,600,700,300&subset=latin" rel="stylesheet" type="text/css">

	<!-- Pixel Admin's stylesheets -->
	<link href="<%=contextPath%>/assets/stylesheets/bootstrap.min.css" rel="stylesheet" type="text/css">
	<link href="<%=contextPath%>/assets/stylesheets/pixel-admin.min.css" rel="stylesheet" type="text/css">
	<link href="<%=contextPath%>/assets/stylesheets/pages.min.css" rel="stylesheet" type="text/css">
	<link href="<%=contextPath%>/assets/stylesheets/rtl.min.css" rel="stylesheet" type="text/css">
	<link href="<%=contextPath%>/assets/stylesheets/themes.min.css" rel="stylesheet" type="text/css">
	<link href="<%=contextPath%>/assets/stylesheets/select2.min.css" rel="stylesheet" type="text/css">

	<!--[if lt IE 9]>
		<script src="<%=contextPath%>/assets/javascripts/ie.min.js"></script>
	<![endif]-->

</head>
<style type="text/css">
.page-signup-alt .panel{
width:40%;
margin:0 auto;
padding:27px}
</style>


<!-- 1. $BODY ======================================================================================
	
	Body

	Classes:
	* 'theme-{THEME NAME}'
	* 'right-to-left'     - Sets text direction to right-to-left
-->
<body class="theme-default page-signup-alt">
	<!-- Form -->
	<form class="panel form-horizontal" id="jq-validation-form" method="POST" style="width:1050px">
		<a href="https://www.cchrint.org/">
			<img src="<%=contextPath%>/assets/images/case/create_header.png"/>
		</a>
		<div class="row">
			<div class="col-sm-12">
				<div class="form-group no-margin-hr">
					<label class="control-label">Email Address</label>
					<input type="text" class="form-control" name="emailAddress" placeholder="Email Address">
				</div>
			</div>
		</div>
		<br>
		<div class="form-actions">
			<input type="submit" value="Submit" class="btn btn-primary btn-lg btn-block">
		</div>
		<hr>
		<a href="https://www.cchrint.org/">
			<img src="<%=contextPath%>/assets/images/case/create_footer.png"/>
		</a>
		</form>



	
	<!-- / Form -->

<!-- Get jQuery from Google CDN -->
<!--[if !IE]> -->
	<script type="text/javascript"> window.jQuery || document.write('<script src="<%=contextPath%>/assets/javascripts/jquery-2.0.3.min.js">'+"<"+"/script>"); </script>
<!-- <![endif]-->
<!--[if lte IE 9]>
	<script type="text/javascript"> window.jQuery || document.write('<script src="<%=contextPath%>/assets/javascripts/jquery-1.8.3.min.js">'+"<"+"/script>"); </script>
<![endif]-->


<!-- Pixel Admin's javascripts -->
<script src="<%=contextPath%>/assets/javascripts/bootstrap.min.js"></script>
<script src="<%=contextPath%>/assets/javascripts/pixel-admin.min.js"></script>
<script src="<%=contextPath%>/assets/javascripts/select2.min.js"></script>

<script type="text/javascript">
	window.PixelAdmin.start([
		function () {
			$("#signup-form_id").validate({ focusInvalid: true, errorPlacement: function () {} });

			
		}
	]);
</script>

<!-- Javascript -->
	<script>var init = [];</script>
	<script>
    
		init.push(function () {

			bootbox.confirm({
				message: "Do you want subscribe to CCHR's email newsletter?",
				callback: function(result) {
					if(!result)
					{
						window.location.href="https://www.cchrint.org/"; 
					}
				},
				buttons: {  
					cancel: {  
                        label: "No",  
                        className: "btn-default"
                    }  
                    , confirm: {  
                        label: "Yes",  
                        className: "btn-primary"
                    }  
                },
				className: "bootbox-lg"
			});
			
			$("#jq-validation-form").validate({
				ignore: '.ignore',
				focusInvalid: true,
				rules: {
					'emailAddress': {
					  required: true,
					  email: true
					},
				}
			});
			
		});
		window.PixelAdmin.start(init);
	</script>

</body>
</html>
